ABSENCE FROM CAMPUS
? Please check this box if you are submitting this form as a revision for time/days previously submitted.
Name: ____________________________________________________________________ Date: _______________________________________________
Work coverage details:
CLASSIFIED: Are there critical areas that must be attended? How will routine functions be covered? Who will assist? Initial below.
__________________________________________________________________________________________________________________________________
ACADEMIC: If classes are involved, how will they be covered? _____________________________________________________________________________
** A copy of this form should be forwarded to the individual(s) who will be covering the duties, please make sure
initialed.
TYPES OF LEAVE
SB = School Business P = Personal IA = Industrial Accident B = Bereavement PD = Pay Dock (Leave without pay)
S = Sick Leave FI = Family Illness V = Vacation C = Comp Time O = Other than codes not already listed
*O=Jury duty, floating holidays, etc
**Please note that Personal time comes out of sick leave
? Please list any differences in times and dates on separate lines unless dates run consistently with equal amount of hours in each day that will be taken.
DATE OF ABSENCE NO. OF HRS TAKEN (and/or) NO. OF DAYS TAKEN TYPE OF LEAVE EXPLANATION (if needed)
____________________ ___________________ _____________________ ________________ ________________________________
____________________ ___________________ _____________________ ________________ ________________________________
____________________ ___________________ _____________________ ________________ ________________________________
____________________ ___________________ _____________________ ________________ ________________________________
____________________ ___________________ ______________________ ________________ ________________________________
________________________________________________________ Approval: _______________________________________________
Employee’s Signature Immediate Supervisor
Approval: _____________________________________________________
______________________________________________________________ Supervising Senior Administrator
Initials of Individual (s) designated to cover duties
Form must be completed by all Palo Verde College employees who will be absent from campus during assigned work hours. In instances where preliminary planning is impossible, e.g. illness, the
employee must contact the immediate supervisor as soon as possible and complete the form upon return to work.
If classes will be missed, the Vice President of Instructions Office MUST be notified so classes can be posted.
White Copy: Administrative Services Yellow Copy: Employee
explanation line what
Type of Leave from
which you want your
“O” taken from.
